Interaction of baseline characteristics with the hazard of encainide, flecainide, and moricizine therapy in patients with myocardial infarction. A possible explanation for increased mortality in the Cardiac Arrhythmia Suppression Trial (CAST).
Why the study?
Do baseline characteristics interact with the mortality hazard of encainide, flecainide, or moricizine in patients with myocardial infarction?
Population
2,491 patients with myocardial infarction and ventricular ectopy suppressible with antiarrhythmic drugs
Comparison
Encainide, flecainide, or moricizine vs Placebo
Design
RCT, randomly assigned, placebo-controlled
Authors
Discussion
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Member takes
Implication
Clinicians should avoid these agents post-MI, especially in non-Q-wave infarction or with diuretic use; extends CAST evidence of subgroup-specific harm.
Structured PICO
Do baseline characteristics interact with the mortality hazard of encainide, flecainide, or moricizine in patients with myocardial infarction?
P
Population
2,491 patients with myocardial infarction and ventricular ectopy suppressible with antiarrhythmic drugs (CAST-I: n=1,498; CAST-II: n=993 with ejection fraction <= 40%)
I
Intervention
Encainide, flecainide (CAST-I), or moricizine (CAST-II)
C
Comparator
Placebo
O
Outcome
All-cause death/cardiac arrest and arrhythmic death/cardiac arresthard clinical
The adverse mortality effects of encainide and flecainide post-MI are particularly pronounced in patients with non-Q-wave MI, frequent VPDs, and higher heart rates, while moricizine hazard is higher with baseline diuretic use.
Cite This Study
Anderson et al. (1994) studied this question.